Sathasivam Hans Prakash, Davan Sangeetha Passu, Chua Szu May, Rohaizat Rahmuna Fazlina, Japar Rohaizam, Zakaria Zahirrudin, Ahmad Abd Razak, Hashim Hasmah, Marimuthu Shashi Gopalan, Liew Yew Toong, Yong Doh Jeing, Vairavan Pappathy, Mohan Singh Avatar Singh, Goh Benjamin Hong Beng, Yusof Zulkifli, Abu Dahari Khairul Azlan Shahril, Haron Ali, Mansor Masaany, Ibrahim Mohd Zambri, Muhammad Abdul Kadar Shiraz Qamil, Hamal Mohamad Hazri, Wan Mohamad Wan Emelda
Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia.
Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia.
Infect Agent Cancer. 2023 Nov 28;18(1):74. doi: 10.1186/s13027-023-00557-0.
In addition to the conventional aetiologic agents of oropharyngeal squamous cell carcinoma (OPSCC) such as tobacco usage, alcohol consumption and betel quid usage, it has been established that a proportion of OPSCC are driven by persistent oncogenic human papillomavirus (HPV) infections. Currently, there is a lack of data on the burden of HPV- associated OPSCC in Asian countries including Malaysia.
A cross-sectional multicentre study with tissue analysis of Malaysian patients diagnosed with primary OPSCC within a five-year period, from 2015 to 2019 between 01/01/2015 to 31/12/2019 was undertaken. Determination of HPV status was carried out using p16INK4a immunohistochemistry on tissue microarrays constructed from archived formalin-fixed paraffin-embedded tissue.
From the cases identified, 184 cases had sufficient tissue material for analysis. Overall, median age at diagnosis was 63.0 years (IQR = 15) and 76.1% of patients were males. In our cohort, 35.3% of patients were Indian, 34.2% were Chinese, 21.2% were Malay and 9.2% were from other ethnicities. The estimated prevalence of HPV-associated OPSCC in our cohort was 31.0% (CI 24.4-38.2%). The median age for the HPV-associated OPSCC sub-group of patients was not significantly lower than the median age of patients with HPV-independent OPSCC. More than half of HPV-associated OPSCC was seen in patients of Chinese ethnicity (54.4%). Patients with HPV-associated OPSCC had a much better overall survival than patients with HPV-independent OPSCC (Log rank test; p < 0.001). Patients with HPV-associated OPSCC with no habit-related risk factors such as smoking, were found to have much better overall survival when compared to all other sub-groups.
The findings from our study suggests that prevalence of HPV-associated OPSCC in Malaysia, though not as high as some developed countries, is however on an upward trend. HPV-associated OPSCC appears to be more frequently encountered in patients of Chinese ethnicity. Conventional risk-factors associated with OPSCC such as smoking, alcohol consumption and betel quid chewing should still be considered when estimating prognosis of patients with HPV-associated OPSCC.
除了口咽鳞状细胞癌（OPSCC）的传统病因，如吸烟、饮酒和嚼槟榔外，已有研究证实，一部分OPSCC是由持续性致癌人类乳头瘤病毒（HPV）感染引起的。目前，包括马来西亚在内的亚洲国家缺乏与HPV相关的OPSCC负担的数据。
开展了一项横断面多中心研究，对2015年1月1日至2019年12月31日这五年间诊断为原发性OPSCC的马来西亚患者进行组织分析。使用p16INK4a免疫组织化学方法，对从存档的福尔马林固定石蜡包埋组织构建的组织微阵列进行HPV状态的测定。
在确定的病例中，有184例有足够的组织材料进行分析。总体而言，诊断时的中位年龄为63.0岁（IQR = 15），76.1%的患者为男性。在我们的队列中，35.3%的患者为印度人，34.2%为中国人，21.2%为马来人，9.2%来自其他种族。我们队列中与HPV相关的OPSCC的估计患病率为31.0%（CI 24.4 - 38.2%）。HPV相关OPSCC亚组患者的中位年龄并不显著低于HPV非依赖性OPSCC患者的中位年龄。超过一半的HPV相关OPSCC见于中国种族患者（54.4%）。与HPV非依赖性OPSCC患者相比，HPV相关OPSCC患者的总生存期要好得多（对数秩检验；p < 0.001）。与所有其他亚组相比，没有吸烟等与习惯相关风险因素的HPV相关OPSCC患者的总生存期要好得多。
我们的研究结果表明，马来西亚与HPV相关的OPSCC患病率虽不如一些发达国家高，但呈上升趋势。HPV相关OPSCC在中国种族患者中似乎更常见。在评估HPV相关OPSCC患者的预后时，仍应考虑与OPSCC相关的传统风险因素，如吸烟、饮酒和嚼槟榔。
